Ptosis associated with pachydermoperiostosis

INTRODUCTION: Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare cause of ptosis. We report the case of a patient with pachydermoperiostosis and bilateral ptosis. The physiopathology and treatment of this ptosis are discussed. CASE REPORT: A 49-year-old patient was referred to our department with ptosis. He had pachydermia of the face, hands and the feet, digital clubbing and periostosis. Examination of the eyelids showed that palpebral apertures were reduced to less than 4mm bilaterally and that eyelids were markedly thickened. All theses features were consistent with the diagnosis of pachydermoperiostosis. Other secondary conditions were ruled out. Ptosis correction was performed by palpebral skin and orbicularis resection as well as tarsectomy. The aesthetic outcome was satisfactory. DISCUSSION: Pachydermoperiostosis is a rare inherited disease, characterized by pachydermia, digital clubbing and periotosis. Ptosis is the result of the palpebral hypertrophia. Excisions of skin, orbicularis muscle and tarsus often give good cosmetic outcomes. CONCLUSION: Pachydermoperiostosis is a rare cause of ptosis, which development is attributed to eyelid thickening. Surgical management has satisfactory cosmetic outcome.